Another option is creating labeling functions within the EHR for children aged 13 to 18 so clinicians can label whether each problem, medication, or diagnostic test result can be accessed by the patient, parents, or both.69 In a recently published scoping review, Wong et al70 further explore possible systemic solutions in designing digital health technology that captures and delivers preventive services to adolescents while maximizing safety and privacy. Survey to assess acceptability of sexual health discussion, STI testing, and pregnancy testing in the ED; verbal explanation of answers also obtained from participants. MI and brief intervention are effective methods to address high-risk behaviors. Study design and risk of bias are presented in Table 1. We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of "HEADS," a mnemonic widely used to obtain a psychosocial . The Newton Screen may be a good brief screening tool for assessing alcohol and cannabis use. endstream endobj 322 0 obj <>stream Patient-administered 22- to 27-item survey on attitudes toward inpatient reproductive health screening and interventions. Of those who ended up needing it, 92% had answered yes before knowing. The APPD Longitudinal Educational Assessment Research Network's First Inconsistent or incomplete adolescent risk behavior screening in these settings may result in missed opportunities to intervene, mitigate risk, and improve health outcomes. Survey to assess sexual history, sexual health knowledge, and desire for sexual health education. Of respondents, 76.5% preferred an electronic survey to face-to-face interviews. The AAP gratefully acknowledges support for the Pediatric Mental Health Minute in the form of an educational grant from SOBI. %PDF-1.7 % Immediate intervention in the ED and receiving information for follow-up care were rated as the most helpful responses to a positive screening result. All children should wear masks in school this fall, even if vaccinated A sexual health CDS system for adolescents in the ED received high acceptability and usability ratings from ED clinicians and adolescents. There is a high unintended pregnancy risk in adolescents using the ED. Of those who participated, 89.2% reported willingness to receive STI testing if it was recommended (regardless of reason for ED visit). The Sexual Health Screen reported on by Goyal et al35 presents a feasible and valid way to screen for sexual and reproductive health. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines flowchart of study selection. Your child's doctor will want to know when and how the injury happened and how your child is feeling. We described and summarized major findings, organized by the following risk behavior categories: comprehensive, sexual activity, mood and suicidal ideation (SI), substance use, and abuse and violence. Prevalence of suicidality in asymptomatic adolescents in the paediatric emergency department and utility of a screening tool, Suicide evaluation in the pediatric emergency setting, Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department, Universal adolescent suicide screening in a pediatric urgent care center, Adolescent and parent attitudes toward screening for suicide risk and mental health problems in the pediatric emergency department, Patients opinions about suicide screening in a pediatric emergency department, Asking youth questions about suicide risk in the pediatric emergency department: results from a qualitative analysis of patient opinions, Adolescent depression: views of health care providers in a pediatric emergency department, Instruments to detect alcohol and other drug misuse in the emergency department: a systematic review, Pediatric Emergency Care Applied Research Network, Reliability and validity of the Newton Screen for alcohol and cannabis misuse in a pediatric emergency department sample, Utility of the AUDIT for screening adolescents for problematic alcohol use in the emergency department, Reliability and validity of a two-question Alcohol screen in the pediatric emergency department, Adolescent substance use: brief interventions by emergency care providers, Screening, brief intervention, and referral to treatment for adolescent alcohol use in Canadian pediatric emergency departments: a national survey of pediatric emergency physicians, Perceived barriers to implementing screening and brief intervention for alcohol consumption by adolescents in hospital emergency department in Spain, Risk factors for dating violence among adolescent females presenting to the pediatric emergency department, Adolescent relationship abuse: how to identify and assist at-risk youth in the emergency department, American Academy of Pediatrics. Fewer than half of respondents used a validated tool when screening for alcohol use. Below we report results by risk behavior domain, with studies organized into subcategories of screening rates, screening tools and interventions, and adolescent, parent, and clinician attitudes toward screening and intervention. The RSQ could not be validated in an asymptomatic population of adolescents and was noted to have a high false-positive rate in this low-risk population (recommended doing more general HEADSS screening). HPAs can be a valuable resource for providing screening and preventive interventions beyond the scope of an ED physician. The ED-DRS is a short but effective tool in screening for mental health risks and can create an environment in the ED for quick, feasible screening and intervention. ED clinicians acknowledged the importance of depression screening. . EC knowledge was poor among clinicians surveyed. In 2009, the Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), a national educational research network, was formed. Pain assessment is an integral component of the dental history and comprehensive evaluation. For anything more than a light bump on the head, you should call your child's doctor. In a 2011 systematic review of substance use screening tools in the ED, the authors concluded that for alcohol screening of adolescent patients, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 2-item scale was best, with a sensitivity of 88% and a specificity of 90% (likelihood ratio of 8.8).55 For marijuana screening, they recommended using the Diagnostic Interview Schedule for Children (DISC) Cannabis Symptoms, which is reported to have a sensitivity of 96% and a specificity of 86% (likelihood ratio of 6.83) and is composed of 1 question. Early childhood is a pivotal period of child development that begins before birth through age 8. Welcome to HEADS-ED. With the heterogeneity of studies included, we could only summarize findings but could not perform a meta-analysis. Adolescents reported interest in receiving education about sexual health topics, such as STIs, contraception, and HIV, in the ED. Documentation of sexual activity screening of adolescents was low in both ED and hospital settings. Moderate to good test-retest reliability was found between questionnaire takers. For intimate partner violence and adolescent relationship abuse, Jackson et al63 outline successful outpatient interventions (eg, universal wallet-sized educational cards and targeted computerized interventions) that could be feasible in the ED setting but would require further investigation. Download ACE Care Plan - Work version ACE Care Plan - School version Concussions: What Parents Need to Know - HealthyChildren.org The HEADSSS assessment is an internationally recognised tool used to structure the assessment of an adolescent patient, encompassing H ome, E ducation/ E mployment, A ctivities, D rugs, S ex and relationships, S elf harm and depression, S afety and abuse. In 75% of cases in which risk behaviors were identified, interventions were provided. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Abstract. Providing decision support to physicians on the basis of survey results led to an increase in intervention (STI testing). Yeo et al13 found that 10% of admitted patients at a tertiary childrens hospital had a comprehensive risk behavior assessment documented (defined as 5 of 7 domains: home, education, activities, tobacco use, drug and/or alcohol use, sexual activity, suicide and/or depression). American Academy of Pediatrics Page of Tools and Descriptions No. One of the best qualities of the HEEADSSS approach is that it proceeds naturally from expected and less threatening questions to more personal and intrusive questions. In several ED studies, authors cited concerns from clinicians that the ED was not the appropriate setting to address sexual activity, particularly if it was not related to the patients presenting problem.39,41 Clinicians in the ED setting had a preference for computerized screening tools as well.42. Seven studies on substance use screening and intervention were included in our review; all took place in the ED setting (Table 4). The ED-DRS, a nonvalidated screening tool to assess for health risk behaviors, was administered by physician trainees. 1 HEADSS is an acronym for the topics that the physician wants to be sure to cover: home, education (ie, school), activities/employment, drugs, suicidality, and sex. Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. These findings were more pronounced in adolescents without symptoms of STI (28.6% vs 8.2%; OR 4.7 [95% CI 1.415.5]).28 In a study by Miller et al29 done in the ED setting, MI was found to be a feasible, timely, and effective technique in promoting sexual health in adolescents. Universal screening reduces missed opportunities to identify children who may have mental health conditions and promotes intervention aimed at preventing some of the long-term effects of a childhood mental disorder. There are limited studies on ARA screening and intervention in the ED setting; however, successful brief interventions from the outpatient setting could be feasibly implemented in the ED. Most adolescents who screened positive did not have mental healthrelated chief complaints, and positive screening results led to interventions in the form of referrals (82% of positive screen results) or urgent admission to an inpatient psychiatric facility (10% of positive screen results). For cannabis use screening, the authors recommend using the DISC Cannabis Symptoms (1 question): In the past year, how often have you used cannabis: 0 to 1 time, 2 times? For alcohol use screening, the authors recommend using the DSM-IV 2-item scale: In the past year, have you sometimes been under the influence of alcohol in situations where you could have caused an accident or gotten hurt? Have there often been times when you had a lot more to drink than you intended to have?, Reviews epidemiology, screening, and MI and brief interventions for substance use. Almost all patients deemed to have elevated suicide risk endorsed SI (SIQ-JR) and/or had a recent suicide attempt. Our findings can help guide efforts in these settings to advance screening and interventions for risk behaviors, thereby improving health outcomes for adolescents. HEADSS: The "Review of Systems" for Adolescents Screening Tools: Pediatric Mental Health Minute Series, Standardized Screening/Testing Coding Fact Sheet for Primary Care Pediatricians: Developmental/Emotional/Behavioral, Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening, Promoting Optimal Development: Screening for Behavioral and Emotional Problems, Recommendations for Preventive Pediatric Health Care, Substance Use Screening, Brief Intervention, and Referral to Treatment, Addressing Mental Health Concerns in Primary Care: A Clinicians Toolkit American Academy of Pediatrics, Links to Commonly Used Screening Instruments and Tools, Long-term Follow-up Care for Childhood, Adolescent and Young Adult Cancer Survivors, Roadmap for Care of Cancer Survivors: Joint Report Updates Recommendations, American Academy of Pediatrics Offers Guidance for Caring and Treatment of Long-Term Cancer Survivors, Childhood Cancer Survivors: What to Expect After Treatment, Transition Plan: Advancing Child Health in the Biden-Harris Administration, Childrens Health Care Coverage Fact Sheets, Prep- Pediatric Review and Education Programs. Additionally, most studies of screens or interventions have thus far been limited to a single study done in 1 center, thus limiting generalizability. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of . Initial evaluation involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established. HEADSS UP: Predictors for Completion of Adolescent Psychosocial Comprehensive Adolescent Risk Behavior Screening Studies. Adolescent Risk Behavior Screening and Interventions in the Hospital Setting. Interview, primary question of interest (asked after standardized suicide screening): Do you think ER nurses should ask kids about suicide/thoughts about hurting themselveswhy or why not?. The HEADS-ED: a rapid mental health screening tool for - PubMed High risk for SI was identified in 93.4% of yes respondents and in 84.5% of the no response group. Head Injury in Children: How to Know If It's Minor or Serious In this study, the terms hospitalized or hospital setting refer to patients admitted to pediatric units under either inpatient or observation status. After a title and abstract screen, 75 studies remained. Adolescents prefer in-person counseling and target education (related to their chief complaint). Behavioral Health ScreeningEmergency Department, Diagnostic Interview Schedule for Children, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, feedback, responsibility, advice, menu, empathy, self-efficacy, home, education, activities, drugs, sexual activity, suicide and/or mood, screening, brief intervention, and referral to treatment. How Pediatricians Screen for Autism - HealthyChildren.org Depression increased, and the American Academy of Pediatrics declared a national emergency in children's mental health." (And to think we called you racist for pleading for open schools.) We also excluded any studies with interventions taking place outside the urgent care, ED, or hospital because we aimed to identify interventions that could be completed during acute care encounters. Forty-six percent of patients were due for the human papillomavirus (HPV) vaccine, and 19% of these received it during admission.25. Sexual history documentation was incomplete in charts of adolescents discharged from the ED with STI diagnosis. Many adolescents felt the ED should universally provide education on sexual and reproductive health practices and provide contraceptive services, especially for patients who may not have access to a primary provider.25,3032 Chernick et al33 found that one-fourth of the adolescent patients in their study were interested in receiving contraception in the ED. Two of the studies took place in the hospital setting and 4 in the ED setting. In a qualitative study, researchers assessed ED physician use of screening, brief intervention, and referral to treatment (SBIRT) and found that <50% of respondents used a validated tool when screening for alcohol use.60 Common perceived barriers were time constraints, inadequate staffing, lack of knowledge of screens, and concerns about parents reactions to screening. In a narrative review by Jackson et al63 on adolescent relationship abuse screening and interventions in the ED, the authors described successful outpatient interventions that could be easily adapted for the ED setting. In the ED, researchers of a single-blind randomized controlled trial tested a computerized self-administered screening tool to identify adolescent patients who were at risk for STIs. A significant proportion of adolescents were interested in starting contraception in the ED. It is important to conduct adolescent substance use screening in the ED. The ASQ, RSQ, CSSRS, and HEADS-ED have been all been validated in the ED setting. A total of 862 charts of adolescents discharged from the ED with an STI diagnosis were reviewed. PDF Mental Health Tools for Pediatrics - AAP Documentation of reproductive health and inpatient delivery of reproductive health services (STI testing and/or treatment, HPV vaccination, and contraceptive provision), Documentation: Fifty-five percent of patients had sexual history documentation. RCT, randomized controlled trial; , not present; +, present. Online Training for Healthcare Providers | HEADS UP - CDC Assessment of Respiratory Function in Infants and Young Children - JAMA Survey of 17 candidate suicide screening questions. Bernstein et al20 used nonphysician providers, or health promotion advocates (HPAs), to perform risk behavior screening and were successful in standardizing comprehensive screening and intervention for adolescents in a busy ED setting by having a dedicated role for the task. If your child is alert and responds to you, the head injury is mild and usually no tests or X-rays are needed. Computerized survey to assess sexual history and interest in interventions in the ED. Teen preferences for clinic-based behavior screens: who, where, when, and how? Approximately 4% of younger adolescents (aged 1315; The AUDIT-10 may be a less useful tool in the younger adolescent population (1315) compared with the older adolescent population (1617) given the low rate of positive screen results in the younger group. All students are required to complete an observed HEADSS assessment over the course of their clerkship. The ACE (Acute Concussion Evaluation) forms are patient assessment tools. Of those, 47% endorsed sexual activity. Written surveys: RADS-2, SIQ-JR, AUDIT-3, POSIT, BHS, and BIS-11; positive suicide risk screen result defined as follows: (1) positive SIQ-JR result or recent suicide attempt or (2) positive AUDIT-3 and RADS-2 results. Use of a visual reminder, such as a HEADSS stamp, on patient charts may increase rates of adolescent psychosocial screening in the ED. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. E-mail: Search for other works by this author on: Achieving quality health services for adolescents, Centers for Disease Control and Prevention, Opportunistic adolescent health assessment in the child protection unit, Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? As physicians, we need to ask about the context of a teen's life, and the HEADSS assessment is a good guide. Marc Olivier: Heads up on Twitter: "RT @nancydoylebrown: David We review studies in which rates of risk behavior screening, specific risk behavior screening and intervention tools, and attitudes toward screening and intervention were reported. To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. Risk for pregnancy was high among adolescent patients in the ED, particularly for those with recent ED use and without a primary care provider. ED and hospital encounters present a missed opportunity for increasing risk behavior screening and care provision for adolescent patients; current rates of screening and intervention are low. However, many barriers to screening in the ED setting were reported. Twenty-five percent never conducted SBIRT (limited time and resources are barriers). An MI-based intervention in the ED may be feasible and effective at promoting adolescent sexual health. Data extracted from the full texts included the full citation, study type, risk of bias, risk behavior domain, intervention or screening tool, results of the study, and conclusions. Six studies met inclusion criteria, and 11 instruments were evaluated (AUDIT, CAGE, CRAFFT, DISC Cannabis Symptoms, DSM-IV 2-item scale, FAST, RAFFT, RAPS4-QF, RBQ, RUFT-Cut, TWEAK).
Redeem Codes For Pba Bowling Challenge For Android,
Rocky Mountain Construction Klamath Falls,
Ralph Garza Jr Related To Matt Garza,
Southern Italian Dna Results,
Articles H